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and ethical authority of parents over children’s medical care is a key part of
their parental role to enhance children’s health. Many literatures showed that,
decision making in childhood cancer is a critical issue to parents as they
required to face a strange situation and to make a decision that will affect
their child health and life span. According to Stewart, Pyke-Gerimm, &
Kelly 2012, it is a nature extension of the parental role to make the correct
decision for their child and ensure the best results. Moreover, they mentioned
that parents often show desire of more involvement in decisions about treatment
than what they actually experience however, few parents preferred physician to
take full responsibility for decision-making because of lack of their medical
experience. Decision making process can be highly ethical if it resulted of
collaboration between the active role of physicians as a result of their
knowledge and experience and parents authority by approving the recommend
choices by physicians (Stewart, Pyke-Gerimm, & Kelly 2012). Therefore, many
protocols and policies have been developed to provide parents with the
appropriate information and help their participation in decision making such as
informed consent. According to McKenna et al., 2009, parents should lead the
decision in treatment choices because they certainly will make the appropriate
decision, while this approach could make parents feel guilty if their decision
did not lead to a desired outcome. Subsequently, health care providers are
required to provide support and information to parents, to help them with the
possible difficulties that might occur during treatment process and enhance
their satisfaction with their decision. Despite parental decisions usually will
optimise the child’s well-being, but sometimes their choices harm the child.
Therefore, Parent’s authority to make medical decisions must not be unlimited
specially when they disagree with the recommended treatment by physician or
withdraw children from treatment, in order to maintain clinical ethics,
parents-physician shared decision making is preferable (McKenna et al., 2009).

of childhood cancer to family is a difficult procedure and requires physician
to deal with many stressors, including decision making in terms of treatment.
Historically physicians are ideally positioned to lead clinical decision making
process. Series of ethical challenges physicians are facing when making
treatment decisions. They are required to weigh the consequences of their
actions; by providing maximum benefit and avoiding harm, as well they are have
to support the role of parents, and consider child’s wishes (Friebert &
Kodish, 1999). According to Simons et al., 2006), physician’s role is to provide
information for patients and their families to enable them to take their own
decision rather than making decisions for them. On the other hand Whitney et al.,
(2006) said, physicians should integrate ethical practice of medicine with the
realities of clinical medicine to ?nd the right treatment choice for oncology
child, and then recommend to child and family a particular clinical decision, especially
when there is one clear best medical option. Ethically, I believe that
physician has the decisional priority to indicate the most effective treatment
approach, based on knowledge and the best available treatment, and then comes
the role of the parents to exercise decisional and legal authority.

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cancer is the cancers that occur in children younger than 18 years. Although
cancer is uncommon in children, it is has been classified the leading cause of
death in children, despite the advances in the treatment of cancer. There are
no known causes of childhood cancer, and it occurs across all ethnic groups;
moreover, some children are even born with cancer. A diagnosis of childhood
cancer is a shock for family and child; it produces major emotional distress,
and affects children and family life balance. The known nature of cancer, being
as life-threatening disease, as well as risks associated with treatment, makes
decision making process stressful and difficult.  According to Whitney et al., 2006, clinical
decision making for children with serious illness such as cancer has a
significant challenge for physicians, parents, and patients, and it is
accompanied with ethical issues. Unlike
treatment decision in adult patient, it is internationally declared that
children under the age of majority are legally ineligible to make decisions
about their own health care. While, parents or guardians are authorized, to
decide for treatment for minor patients, however, medical decisions must be
based on the child’s best interest, such treatment effectiveness, possibilities
of additional suffering from side effects, and overall prognosis. Furthermore,
healthcare professionals and related ethical issues can affect also decision
making in childhood cancer. Accordingly, this paper aims to discuss number of
key themes related to decision making in pediatric oncology;  physician’s role in decision making in
childhood cancer; parents’ participation in treatment decisions and the factors
that might affect their decisions; parent’s view of participation of child in
clinical trials. Following this, I will look at particular aspects with ethical
dilemmas: refuse of treatment, do not resuscitate (DNR) in children, and
end-of-life care for children. Finally I will offer own thoughts and hypothesis
about topic.

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